Use IHealth software, not paper, defiant Nanaimo doctors told.

Island Health says it will no longer accommodate Nanaimo doctors who are refusing to use an electronic system for ordering medication — a system the doctors say puts patients at risk.

Nine internal medicine doctors at Nanaimo Regional General Hospital stopped using the $174-million electronic health records system at the end of April in protest.

The internists join doctors in the emergency and intensive care units who went back to entering medication orders using pen and paper because of their concerns. They say some medication and test orders have disappeared, and some dosages have changed, endangering patients.

Island Health responded by asking other physicians to enter the internists’ handwritten orders into the system.

But that has to stop, said Island Health CEO Dr. Brendan Carr. The practice leads to a greater likelihood of error, miscommunication and liability issues.

“By adding another physician as an intermediary, it slows all of that down and then it creates other risks, because you have one physician trying to interpret what the intention of another doctor was,” Carr said.

It’s also too late for the internists to go back to pen and paper, he said.

The emergency and intensive- care units are able to do it because those departments never fully transitioned to electronic health records, but that’s not the case for internal medicine, Carr said.

“We don’t have the systems in place to deal with paper orders anymore,” he said.

Dr. David Forrest, one of the internists who stopped using the system, said Island Health’s decision to stop accepting paper orders puts him and the other doctors in a difficult situation.

“It has the effect of barring me from practicing — suspending my ability to practice without actually suspending me,” said Forrest, who is president of the Nanaimo Medical Staff Association.

“That left me in a situation of having to essentially transfer care of my patients to somebody else. Which was an issue because, in my view, from an ethical standpoint, I’m concerned about putting my patients in the middle of all of this.”

Forrest said the protesting internists wanted to try to get the health authority to suspend use of the system so it could be redesigned.

“But the other value, frankly, of having the orders on paper is that it provides a permanent, continuous visible record of the orders, as intended by the physician,” Forrest said.

Carr said Island Health wants to address the core of the problem, which isn’t the electronic system itself, but the way it reduces communication between staff. Errors occur not because the computer makes orders disappear, he said, but when another medical professional down the line adjusts orders without communicating directly with the doctor who entered them.

In the past, there were more phone calls between physicians and other medical staff who might adjust an order when they become aware of patient sensitivities to certain medications, for example, Carr said.

“We should be working together to develop a system that can monitor the downstream effects, identify potential weaknesses and intervene to make it better,” he said.